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Within the field of pornography research, there are many challenges that arise due to strong opinions and feelings on the topic. Confirmation bias is prevalent due to societal taboos surrounding pornography. While many studies hypothesize about and study negative effects of pornography, few researchers explore potential benefits or positive aspects of pornography. A large percentage of studies suffer from methodological issues. In one meta-study by researchers at Middlesex University in England, over 40,000 papers and articles were submitted to the team for review and 276 or 0.69% were suitable for consideration due to the low quality of research within the field.[13]

In Effects of Prolonged Consumption of Pornography, a review of pornography research conducted for the Surgeon General of the United States in 1986, Zillmann noted that inconsistencies in the literature on pornography exist, but overall concluded that extensive viewing of pornographic material may produce some sociological effects he argued were negative, including a decreased respect for long-term, monogamous relationships, and an attenuated desire for procreation.[14] He describes the hypothetical basis for these conclusions stating:

The values expressed in pornography clash so obviously with the family concept, and they potentially undermine the traditional values that favor marriage, family, and children ... Pornographic scripts dwell on sexual engagements of parties who have just met, who are in no way attached or committed to each other, and who will part shortly, never to meet again ... Sexual gratification in pornography is not a function of emotional attachment, of kindness, of caring, and especially not of continuance of the relationship, as such continuance would translate into responsibilities, curtailments, and costs ...[15]

Other contemporary researchers disagreed, McKay & Dolf noting "neglected in work on pornography is that adults capable of functioning in contemporary society are also quite able to distinguish the difference between reality and fantasy. That such a point requires stating is indicative of the overly simplistic model of human behaviour which is reflected in this type of work."[16]

The effects as Gail Dines summarizes Zillman's 1989 study, include "alters perceptions of sexuality; specifically, it fosters presumptions of popularity for less common sexual practices; breeds discontent with the physical appearance and the sexual performance of intimate partners; trivializes rape as a criminal offense and also trivializes sexual child abuse as a criminal offense; and promotes insensitivity toward victims of sexual violence and promotes men's beliefs that they would be capable of committing rape. In addition, habitual male consumers of common pornography appear to be at greater risk of becoming sexually callous and sexually violent toward women than occasional users."[17][18]

Avedon Carol has explained of Zillmann's term "sexually callous" that he meant "a greater tolerance for homosexuality; a belief that women should be able to choose other priorities beside motherhood; less belief in marriage; a belief that women may enjoy sex and choose to participate in it for reasons other than pleasing their husbands or conceiving children - in short, the goals of most feminist groups of the time. Zillmann was unable to demonstrate any increase in misogynist or violent attitudes and desires, although he did try." and stated of the sponsor of the report "Having noted the varied interpretability of Zillmann and Bryant's findings, the [USA] Surgeon-General's report said that the only reliable findings of the research that supposedly proved men were more callous towards women after looking at pornography was this: the group that saw pornography estimated more accurately the prevalence of sexual practices in society. The control group, which did not see the material, tended to underestimate grossly how common certain sexual acts were" and commented "But even this result may be less reliable than it appears, due to methodological problems. Zillmann and Bryant had tried to include non-students in their research, but many of them left the study group when they discovered they would be asked to look at pornography. This meant that the control group contained a different population - older, perhaps more settled married men, for example - and thus any differences in the answers the groups gave to the questions might only reflect different attitudes among the different groups, and not pornography effects at all. The study was no longer controlled. In the end, the research may only mean that older, married men are less critical of their partners than young, single psychology students, and that such young, educated men have more liberal attitudes about women's roles and homosexuality, and more realistic knowledge of sexual practices in society."[19]

Pornography addiction is a purported behavioral addiction characterized by compulsive, repeated use of pornographic material until it causes serious negative consequences to one's physical, mental, social, and/or financial well-being.[20][21][22] However, there is no diagnosis of pornography addiction in the current Diagnostic and Statistical Manual of Mental Disorders (DSM-5).[20] The DSM-5 considered the diagnosis of hypersexuality-related behavioral disorders (to which porn addiction was a subset), but rejected it because "there is insufficient peer-reviewed evidence to establish the diagnostic criteria and course descriptions needed to identify these behaviors as mental disorders."[20] Instead, some psychologists suggest that any maladaptive sexual symptoms represent a manifestation of an underlying disorder, such as depression or anxiety which is simply manifesting itself sexually, or, alternatively, there is no underlying disorder and the behavior simply is not maladaptive. These psychologists do not recognize the concept of addiction, only chemical dependence, and believe the concept and diagnosis to be stigmatizing and unhelpful.[23][24]

Two 2016 neurology reviews found evidence of addiction related brain changes in internet pornography users. Psychological effects of these brain changes are described as desensitization to reward, a dysfunctional anxiety response, and impulsiveness.[3][4] Another 2016 review suggests that internet behaviors, including the use of pornography, be considered potentially addictive, and that problematic use of online pornography be considered an "internet-use disorder".[5]

A controlled study describes the relationship between given behaviors or environmental conditions and health effects in a laboratory setting in which conditions other than those under study are effectively held constant across groups of participants receiving various levels of the experimental condition(s). Since it is considered that the only functional difference between groups is the level of experimental condition(s) received, researchers can strongly infer cause-and-effect relationships from statistically significant associations between experimental condition(s) and health consequences. Thus, if executed properly, controlled studies have high levels of internal validity. However, such studies often suffer from questionable external validity due to the considerable differences between real-world environments and the experimental context, and the consequent belief that results cannot be generalized beyond that context.[25]

The link between pornography and sexual aggression has been the subject of multiple meta-analyses.[26] Meta-analyses conducted in the 1990s suggested to researchers that there might not be an association of any kind between pornography and rape supportive attitudes in non-experimental studies.[27] However, a meta-analysis by Hald, Malamuth and Yuen (2010) suggests that there is a link between consumption of violent pornography and rape-supportive attitudes in certain populations of men, particularly when moderating variables are taken into consideration.[26]

A meta-analysis conducted in 2015 found that pornography "consumption was associated with sexual aggression in the United States and internationally, among males and females, and in cross-sectional and longitudinal studies. Associations were stronger for verbal than physical sexual aggression, although both were significant. The general pattern of results suggested that violent content may be an exacerbating factor."[28][unreliable medical source?]

In an earlier review of this literature Ferguson and Hartley (2009) argued that "it is time to discard the hypothesis that pornography contributes to increased sexual assault behavior".[29] They stated that the authors of some studies tended to highlight positive findings while deemphasizing null findings, demonstrating confirmation bias in the published literature. Ferguson and Hartley concluded that controlled studies, on balance, were not able to support links between pornography and sexual violence.

An epidemiological study describes the association between given behaviors or environmental conditions, and physical or psychological health by means of observation of real-world phenomena through statistical data. Epidemiological studies generally have high levels of external validity, insofar as they accurately describe events as they occur outside of a laboratory setting, but low levels of internal validity, since they do not strongly establish cause-and-effect relationships between the behaviors or conditions under study, and the health consequences observed.[25]

Danish criminologist Berl Kutchinsky's Studies on Pornography and sex crimes in Denmark (1970), a scientific report ordered by the Presidential Commission on Obscenity and Pornography, found that the legalizing of pornography in Denmark had not resulted in an increase of sex crimes.[30] Since then, many other experiments have been conducted, either supporting or opposing the findings of Berl Kutchinsky, who would continue his study into the social effects of pornography until his death in 1995. His life's work was summed up in the publication Law, Pornography, and Crime: The Danish Experience (1999). Milton Diamond from the University of Hawaii found that the number of reported cases of child sex abuse dropped markedly immediately after the ban on sexually explicit materials was lifted in 1969.[31]

Some researchers claim there is a correlation between pornography and a decrease of sex crimes,[6][7][9][10][11][12] including Diamond (author of a review from 2009).[8]The effects of Pornography: An International Perspective was an epidemiological study which found that the massive growth of the pornography industry in the United States between 1975 and 1995 was accompanied by a substantial decrease in the number of sexual assaults per capita, and reported similar results for Japan.[32] Findings of this nature have been critiqued by Robert Peters, president of Morality in Media, on the grounds that the results are better explained by factors other than the increased prevalence of pornography: "a more plausible explanation is that if there is a decline in "forcible rape," it is the result of a tremendous effort to curb rape through community and school-based programs, media coverage, aggressive law enforcement, DNA evidence, longer prison sentences, and more."[33]

In 1986, a review of epidemiological studies by Neil M. Malamuth found that the quantity of pornographic material viewed by men was positively correlated with degree to which they endorsed sexual assault.[34] Malamuth's work describes Check (1984), who found among a diverse sample of Canadian men that more exposure to pornography led to higher acceptance of rape myths, violence against women, and general sexual callousness. In another study, Briere, Corne, Runtz and Neil M. Malamuth, (1984) reported similar correlations in a sample involving college males. On the other hand, the failure to find a statistically significant correlation in another previous study led Malamuth to examine other interesting correlations, which took into account the information about sexuality the samples obtained in their childhood, and pornography emerged as the second most important source of information.[34] Malamuth's work has been criticized by other authors, however, such as Ferguson and Hartley (2009) who argue Malamuth has exaggerated positive findings and has not always properly discussed null findings.[29]

The AIDS Healthcare Foundation tried several times to have California’s Department of Industrial Relations, Division of Occupational Safety and Health’s Appeals Board force companies in the pornography industry to treat actors and actresses as employees subject to occupational safety and health regulation; in a 2014 case brought against Treasure Island Media an administrative judge found that the company did have to comply with regulations.[38]

In the United Kingdom, the Association of Teachers and Lecturers feels schoolchildren need to be educated about pornography and warned what is reasonable and what is not acceptable.[39] The UK children's commissioner initiated a meta-study conducted by researchers at Middlesex University which concluded that pornography is linked to unrealistic attitudes about sex, beliefs that women are sex objects, more frequent thoughts about sex, and found that children and young people who view pornography tend to hold less progressive gender role attitudes.[13] Miranda Horvath stated about this: "But it is not possible to establish causation from correlational studies, and to say whether pornography is changing or reinforcing attitudes."[13]

^McKay, H.B.; Dolff, D.J (1984). 'The Impact of Pornography: An Analysis of Research and Summary of Findings'; Working Papers on Pornography and Prostitution Report No. 3. Department of Justice, Canada.

^ abcAmerican Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Arlington, VA: American Psychiatric Publishing. pp. 481, 797–798. ISBN978-0-89042-555-8. Thus, groups of repetitive behaviors, which some term behavioral addictions, with such subcategories as "sex addiction," "exercise addiction," or "shopping addiction," are not included because at this time there is insufficient peer-reviewed evidence to establish the diagnostic criteria and course descriptions needed to identify these behaviors as mental disorders.